“Shoe Shop” Lacing Technique: A New Biceps-Augmented Knotless Suture for Arthroscopic Rotator Cuff Repair

Rocco Bonfatti, M.D.
Austin F. Smith, M.D.
Antoine Ledoux, M.D.
Yves Lefebvre, M.D.
Lionel Neyton, M.D.

Significant advancements have been made in the treatment of complex rotator cuff tears over the past several decades. New repair techniques aim at improving construct biomechanics and promoting favorable healing. For massive tears, the side-to-side technique based on margin convergence described by Burkhart et al.1 as a knotted technique has shown satisfactory outcomes. This type of repair alleviates pain through decreased mechanoreceptor stimulation and reduces overall strain, decreasing the tear gap size, with each additional suture demonstrating a standard rotator cuff repair using suture anchors.2 Despite the development of strong sutures and various modifications of the technique, recurrences still occur, and certain tear patterns remain challenging to manage. Specifically, when the anterior remnant of the superior-anterior cuff is completely absent or weak, margin convergence is not a feasible option.3 In such tear patterns, Richards and Burkhart4 proposed integrating the long head of the biceps tendon (LHBT) in the repair.

In this article, we present the arthroscopic “shoe shop” lacing technique: a knotless, side-to-side, and tendon-to-bone suture technique that involves the biceps as an anterior cable augmentation.
The suture-passing (single-running) method described is convenient and efficient, and this is why it has been used by retail stores’ employees to prelace some footwear to facilitate the fitting process for customers. It was also employed by the British military for the additional benefit of having an easy-to-cut upper horizontal section, facilitating the removal of a boot from an injured ankle or foot.

The ease of construction and the durability of this side-to-side and tendon-to-bone suture technique make it an intriguing choice for arthroscopic repair in anterior margin–deficient patterns of complex massive rotator cuff tears.